Category: Neuroplastics Diary

Three months ago, I did a thirty day challenge of writing daily blog posts about my experience using neuroplastic techniques to come out of persistent pain. At the time I had no definable cause for the pain. In the subsequent two months I’ve had scans that confirm whiplash-associated arthritis where my head joins my spine.

Despite the lack of updates in that time, I have mostly kept up the pace with visualisation. My routine is a thirty minute sit (visualisation not meditation) before anything else each morning, another sit after breakfast and one more before bed. These are scaffolding. They keep the imagery fresh enough in my mind that I can recall it as needed while going about my daily tasks for the rest of the day.

Yes, the pain spikes still happen. I still have damage to my neck. I use a subjective scale of pain from one to ten, one being pain free and ten being dropped in boiling oil. And the pain spikes are still at the 6/10 that they were before starting the visualisation.

(Of course, comparing levels of pain is where a subjective scale becomes unreliable but it has to suffice, given that pain is a perception. There can be no objective measure of pain.)

That’s where the similarities end, however. In other ways, the most astounding changes have occurred:

I can get the pain to stop. If I’m diligent and prepared to prioritise visualisation whenever a pain spike hits (any time of day or night, even if this means sacrificing the task or timeline I’m running with) then I can get rid of it. There are exceptions, but generally the pain recedes. After a ten minute break, I can carry on with my day. (Major flare ups are a whole ‘nother ball game that still require me to drop everything for a day or two. I have other tactics in place to avoid them, see below).

Two-hours pain free is now a daily occurrence. I can now be pretty much guaranteed of a period in the afternoon where I can work, move around, talk etc without needing to stop and visualise or take breaks. It’s like I’m back to my old self for those couple of hours.

Note that both these effects are occurring while completely free of painkillers 🙂 No paracetamol (aka acetaminophen for my US readers). No ibuprofen. No codeine and definitely no tramadol.

To me, this is worth any amount of slow-down, drop-everything-and-visualise type behaviour that I need to undertake for the rest of the day in order to attain the pain free states.

That’s the good news.

Major Pain Triggers

Six months ago I had to limit my activities to avoid what I’m calling “major flare ups”. Usually lasting two days, but sometimes up to four, even visualisation brings no relief during these periods. Restorative yoga and sleep is about the only thing for me.

Those limitations persist — that’s the bad news. Unfortunately for me (and my erstwhile yoga students) they include actions that are commonplace in many asana. Downward dog or plank pose shoot whole body pain and headache into my eyes, confusion, nausea, visual field like a broken mirror, tiredness. Shortness of breath. Ringing in my ears. So I’m still not back on the regular teaching circuit. I don’t know if I ever will be, now that we’ve discovered the arthritis.

My physio gave me an ingenious set of exercises. Attach a laser pointer to your glasses frame, and use it to draw around door frames etc from a distance of three metres. This is to retrain the tiny muscles at the base of your skull. If you have a laser pointer, try it! But they’re no good for me. It’s great training for those muscles, but the actions flare up the actual joint itself so I’m in bed the next day. For a couple days.

I’ve also had to limit or eliminate heavy lifting and hammering (so no DIY for me), computer use for more than half an hour without a break to move around, driving for long periods. Even just being in a hurry can start me on a spiral that can lead a strong burst of long-lived pain. So I’ve had to slow down my life a lot just in general.

Realistic Recovery

Speaking loosely, I wouldn’t call it “normal life” yet, but it’s heading that way. I can approach each day with more optimism, just knowing that each afternoon I will get a period of relief. And knowing that, if I am sensible and realistic about my activities through the day, then I’ll be able to head off pain spikes as they occur. It feels manageable.

It’s tricky to remain realistic with those activity goals after so long being on tenterhooks. Staying realistic without stifling the optimism — that’s the next phase of this recovery journey.

I’m fumbling my way a bit. In the past I relied on my gung-ho attitude to get me through just about any confusing situation (“fake it till you make it”). That won’t cut it here. I need to develop the patience, persistence and self-awareness to chip away at tasks without going into hyperfocus mode on them. An hour here, an hour there and plenty of walks and breaks in between.

If you have any tips to share with me about realistic recovery please share them in the comments. I’m particularly looking to learn more about my warning signs when I’ve overdone it, ways to structure a day so I can get the most out of them while remaining true to my capacity. Useful activity worksheets, for people in recovery. Forums or blogs to follow … I’ll collect any suggestions, plus what I learn from my own experience and research, and put them into a future post to follow soon.

Because the visualisation is now an integrated part of my day, I have less need of a ritual around composing a daily blog post on the subject. The main purpose of these posts (as I mentioned a while ago) was to serve as a social hack that helped me build a habit of visualising relentlessly. But I’m starting to feel established in the technique now. So, thirty days of blogging later, I feel like I’m coming to the end of these daily updates.

Not that the visualisations have run their full course. Far from it. Although I see promising signs every day now that the technique is starting to work (especially on Friday when I was completely pain-free for two hours), still the full benefits won’t be known for months yet, possibly even a year or two. I have a long way to go yet, and plenty of content in mind on this topic and others, so you’ll continue to hear from me fairly frequently I’d say.

I’ve had contact lately with a few people who are working with this technique. Some of our chats have made it into articles here on the site, in some form or other. I hope this diary can continue to serve as a resource for others who are putting neuroplastic visualisation into practice, or at least as a starting point for conversations.

In the meantime, why not get in touch at my Facebook page or on my blog (links below)? Let’s hack our brains together 🙂

Unlike a simple sense impression such as taste or smell, pain seems to be a fully-fledged, mind-body experience. We don’t just feel pain — we are gripped by it almost like an emotion or mood. How does that happen? Does pain always correlate with injury in the body? I’ll try and keep this short, and as jargon-free as possible!

Fancy a warm day at an idyllic beach. Wading towards the shore after a long leisurely swim, gazing around at the sunlight on the waves, you unexpectedly stub your toe on a submerged rock. Let’s use that example to analyze what’s going on as you suddenly find yourself dealing with a flurry of unpleasant feelings.

Nociception

I know, you’re like noci… wha?? Jargon straight up! Don’t stress — I never heard this word until a couple months ago either. But this is the only jargon for the whole article, ok? Bear with me …

Roughly speaking, nociception is the name for the pain signal before it reaches the brain. Interestingly enough, nociception itself does not cause much of a reaction in the area where the injury happens.

In the case of your accident at the beach, it is not until your brain receives a signal from the toe, that any kind of response begins to take place.

Nociception vs Pain

When we get a signal that “something hurts”, how does that expand into such a rich experience that all or most of our concentration and our emotions are suddenly turned towards it?

Well, as soon as your brain receives the nociception signal it does some trickery to figure out how bad the damage is (if you just scratched yourself or if you cut yourself deeply). It also looks into where the signal is coming from and how easily damaged that area tends to be (if you stub your toe it hurts more than if you hit your arm).

You’re already starting to feel things in a context that is more than just simple nociception. Next up perhaps memories will crop up of the last time you stubbed your toe, you’ll lift your foot out of the water and examine it closely. Your eyes and visual parts of your brain will be processing all those images. If you’re like me you’ll be wondering if anyone has noticed and if you perhaps look a trifle silly standing on one leg in the water with your other foot held up in front of you. You’ll be trying not to topple over.

Our mind has gone from soaking up the summery day, to a more active state. After the initial fast signals, the toe is now sending slow throbbing nociception signals to our brain, and every time a new throb reaches our brain, it goes through that whole activation state again. It returns our focus to our foot from whatever else might be going on. Now we are experiencing pain.

What’s interesting is that nociception and pain can be experienced separately. While normally of course, nociception does lead directly to an experience of pain, in some cases it is possible to experience great amounts of nociception but to be in an entirely pain-free state. This is sometimes noticed in cases of “massive trauma” [2] by paramedics in victims at the site of a car crash.

The opposite is also possible, for example when “individuals with functional pain syndromes report considerable anguish in spite of having [no measurable -nociceptive activity]”. [2]

Pain as a Perception

These understandings and many more led Ronald Melzack, a Canadian who studied phantom limbs and pain, to refer to pain as an “output of the central nervous system”. (Ok, a tad more jargon. “Central nervous system” is a medical term for the brain and spinal cord.)

What Melzack is saying here is that although pain does start starts in the site of injury, it is not until it is taken into the central nervous system and evaluated as being important enough to warrant attention, that the pain begins to intrude on our thoughts and emotions. This is more like a perception, where we are not just receiving sensory input but thinking about it and evaluating it.

Although this may seem quite obvious, you can see that rolling all of this together and calling it “pain” turns pain from being a simple realisation that “something hurts” to being the full mind-body response to an incident of nociception, and not just the nociception itself. Linking it all together like this is the only way to explain complex pain syndromes like those outlined above, or in the case of a phantom limb causing pain, where the pain persists in the brain long after the nociception has ceased.

The particular brain regions that are involved in taking up the call of pain, on behalf of the nociception from the site of injury, in order to generate this “output” are many. Moskowitz identifies no fewer than sixteen different brain regions! [3] and [4] Many of these are connected with our emotions and our thinking patterns, and others are connected with our body’s most basic self-monitoring and survival systems.

This explains why pain can be such a distressing experience, and why we sometimes shrink away even from the thought of hurting ourselves. The emotional centres of our brain are anticipating our potential distress and creating aversive reactions before the pain has even happened, by simulating the pain independently of receiving any actual nociception.

Conclusion

I’ve found this knowledge to be the start of a whole investigation into the nature of pain. Knowing that pain is partly to do with how I evaluate it, and not just a result of being told “something hurts” by my body, has been quite an eye-opener for me.

I hope you’ve found it interesting too. If so be sure to like my Facebook page or follow my blog for more updates. I write about wellbeing and mindfulness, with a few creative pieces thrown in from time to time.

Further Reading

Here are some useful links I’ve found while reading about pain theory.

When you’ve been in constant pain for a long time, it’s pretty weird when the pain suddenly disappears. It’s like when snow begins falling after promising all day to do so … there’s no fanfare, no flashing lights. Occupied with walking, soft whispers of cold touch your cheeks, your throat. Whirl into your eyelashes. You pause transfixed and watch the motes appear from grey-brown sky.

I who had forgotten wonder, only to have it fall in countless drifts, each tiny moment fresh and precious. Gone, but followed by a million, a trillion more, endless snow descending with silent life to Earth.

Great soul of the sky, lend me strength through thrill of your touch but lead me not to clutch your wonder too tight. Let me be afraid not of snow nor summer sun but free to spin instead with every gust of air that fills your gulf.

Section Two of Moskowitz’s book[1] goes beyond visualisation to the sense of touch. This is particularly helpful when the pain is long-running. Sometimes, I’ll do visualisation and that pain is gone by the end of it. Was it the visualisation that caused the pain to diminish? Impossible to say really. But when the pain doesn’t decrease, I’m using some of the techniques in Section Two as a way of flooding the brain with other input.

Some of the suggestions are very simple. Rub your thumb-pad with your forefinger to stimulate touch sensations in the brain that are not painful. He also advocates brushing the skin over a painful area very lightly with a finger, or a cold glass, or even things like feathers and shaving brushes! All to stimulate nerves in the area other than pain receptors. Some of these suggestions are more in the realms of traditional advice you’d receive from your friend. You have a back ache or a “crick in your neck”? Take a warm bath.

Gently rubbing an area where there has been almost constant pain is not a small deal. In fact, when I take two fingers and just rest them lightly on the skin in my left-hand-side clavicular fossa[4], I feel a high-pitched throbbing down the underside of my left arm, through my elbow into my little finger, and a circle on the top of my head and the orbit of my left eye both set up sympathetic aches. In this case, Moskowitz recommends placing your fingers just to the side of the painful area, as near as possible without firing off the nerve that is hypersensitised.

We are not taking a warm bath or rubbing a painful area to achieve temporary relief but in order to reduce the dominance of pain processing in our brain. The idea again is to approach it with the MIRROR acronym in mind:

The key is to stay Motivated. Have the Intention of changing your brain. Be Relentless in opposing any and every pain intrusion into your consciousness. Rely upon your brain’s ability to adapt and make considerable initial efforts automatic and seamless. Approach each pain intrusion as an Opportunity to hone and master this proactice and make it automatic and effortless. Expect your brain to Restore itself and work on these approaches until it does so.Michael Moskowitz MD [2]

So we don’t need to be discouraged when the pain doesn’t go away, or returns immediately. We weren’t expecting any relief in the first place, necessarily. Just as in the visualisation we used imagery to “access” the pain centres and direct them to process other input, so now with the sense of touch we are starting to use the nerves outside of the brain and spinal cord (the peripheral nerves) to access the brain for the same purposes.

A further suggestion that Moskowitz makes is to receive regular gentle massage from a skilled therapist [3]. As a trained massage therapist myself, you’d think this would have been obvious!

Visualisation now is more refined again; colours fade gradually through all the colours of the rainbow including indigo, violet to black. I’ve two versions. One of these versions — we’ll call it the “full-cream” version — I use just for the more focussed sessions (when I stop what I’m doing and close my eyes). It has a lot more detail, eight different regions of colour fading through all colours of the rainbow and each colour in between to black. Whereas when I’m more active and moving around, I go for a more “lite” version. I mentally zoom in on just one of these regions and fade it through as many colours as I can before distraction sets in. Often that’s just red through orange to yellow. Or sometimes I start with violet and just let it fade from there to nothing.

I’m writing absent-mindedly at present because I’m visualising at the same time.

Another setback today, which I’m using as an opportunity to practice my visualising “in anger” as they say — in the extremity of a strong flare up of pain, after an awful gapping sensation in C3-C4 region on the left-hand side of my neck.

Was all chill, sitting before the fire, warm as, reached up with right hand to adjust my hairtie and turned my head as I did so to provide more leverage. As you do. Weird graunchy clunk that my son heard from across the room and zing, pain in the origin of my left-hand anterior scalene over Rib 1 and 2 and sudden body bracing from top of torso to bottom. Last night and all today — drop everything and visualise, constantly. Takes an hour to wash a small load of dishes because I keep pausing to hallucinate haha.

I’m not sure if it’s recommended to visualise so intensely as I’m doing, it takes 2-3 minutes each time I do it if I go the full version. Perhaps it’s better to have a lean, quick little visualisation more often, than less frequent visualising for a longer duration? A bit of both perhaps — I guess that’s what I’m doing with my “lite” version and my “full-cream”.

But when I do the lite version, I don’t get the same level of pain relief — often, pain is still intruding on consciousness. So by Moskowitz’s “Relentlessness” rule, I should visualise again… That kind of repeated visualising eventually uses as much time as the “full-cream” practice. But the difference is, I can get things done at the same time, albeit slowly.

I stopped for a couple of minutes for every line of the last paragraph. Just did it again.

I’ve noticed lately that there’s a rhythm that the colours emerge to — sometimes the colours cycle rapidly, other times it’s slow. Until now I’ve always tried to slow that down so I can get more high-resolution in the fades, but just now I went with the natural pacing and it felt more calm, relaxing, helped with the pain and went more quickly too. So I’ll go with the rhythm it seems to want from now on.

I just did some trigger pointing of my upper trapezius – often the only thing that gives me relief during a flare up of this magnitude. Usually when I have acute LHS neck pain they’ll be eye-watering to the touch. Today, hardly noticeable when I pincer-grip them.

Trigger points work by being adjacent to pain signalling neurons within the “body maps” of our somatosensory cortex. And they’re often firing due to neuronal spillover from the “neuroplasticity gone wild” of chronic pain. I they’re not online today, especially given how much pain I’m feeling just in general, could that indicate I am slowly shrinking the spillover?

Maybe I’m particularly prone, but to me it’s amazing how subconscious we can be in our routines. When I successfully gave up smoking fourteen years ago, it was only the last in a line of attempts, dozens-long. Each attempt on that line was a step towards the outcome I eventually crafted. I got discouraged after the early attempts were unsuccessful until I realised this.

Those first few attempts I tried to “break the bad habit”. But fighting with myself just lead to stress. What’s a common way to unwind when you’re stressed? Settle into something familiar like (for me) rolling a durry. Boom, smoking again. That’s what some of my early attempts looked like. I’d literally be sitting there smoking before I remembered how I was supposed to be quitting.

To an extent, life is about habits. They keep us alive and well (think of the many habits we use while driving, or the habits of hygiene). It’s useful to do things habitually. The problem is when we discover the need to change a behaviour pattern. Our brains are very good at forming, but not so good at “breaking” these routines.

I’ve learned from the smoking experience that it’s not helpful to create the intention to cease a habit. That just sets up internal conflict — a fight with yourself, resulting in stress. At the very least, stress saps motivation. If you’re unlucky, the habit will resurface as a coping mechanism for the stress that you’ve created by trying to get rid of it! Instead, much more helpful is to look at replacing that habit with another, beneficial one. [1]

When we replace an old habit with a new one, we are creating a competition between the two, and if we continually feed the desired habit, the undesired one will become weaker and weaker.

This is making use of competitive neuroplasticity. It applies equally well when working to unwind from persistent pain. We must replace the body’s neuro-inflammatory habit of wind-up pain with other habits and continually feed this habit until we weaken the pain pathways for good. Like an ex-smoker, we then need deal only with the occasional flare-up.

As a twenty-four-year-old, I somehow cottoned on to this. Once I reframed each “failed” attempt as actually a step on the path to being free of smoking, I started looking at these steps as crucial learning that I could take into the next time around the cycle. I was evolving a set of new habits like tools, that eventually did win out. Smoking was just smoking. It wasn’t evolving. There was no way I could lose — it was just a matter of time.

Today I’m digging deep, returning to the visualisation technique after three days in no-man’s-land due to gastro. I find that I’ve fallen behind by about a week from where I was in terms of motivation, clarity of visualisation, pain relief. All those are cloudy.

I just want to break the cycle. I want to work my body. I want to stretch myself to create things no one’s ever seen, to seek things I’ve never seen. But I know what happens when I follow those urges. If I ignore what’s wrong in my body, the flare ups return. There’s no escaping.

The frustration is real. I just want to break the cycle. But frustration leads to stress. Stress leads to tension. Tension leads to pain. Boom, back to square one, just like smoking.

So I regather myself, re-reading passages of neuro-biology to return a sense of motivation, visioning my particular imagery to activate networks only four weeks old in the competition vs those four years old. I remind myself that this is crucial learning. Resilience in the face of setbacks is how we effect lasting change.

Bene Gesserit Litany Against Fear by Frank Herbert in “Dune”

[1] I just found that James Clear has talked about the same thing. I must say, I’m not a fan of that pop-psychology stuff that reduces all of these lessons to little flow charts and worksheets. It seems a bit sterile. But he does present a similar idea here, and it’s worth a read: http://jamesclear.com/how-to-break-a-bad-habit

Days 26 and 27 went by in an unfortunate episode of unwellness completely unrelated to whiplash or neurology but entirely to do with a bad choice of takeaways on Friday night! Amazing dreams, worthy of Salvador Dali. On speed. At a masquerade ball. I’m largely on the mend today, but let me just say there’s nothing like being under attack by truly vigorous bacteria to remind us how our mind is so much an embodied arising of consciousness. Change the body, and the mind changes drastically.

Needless to say, I don’t have a lot to report for today. Although I have dim memories of visualising while in the throes of gastro, it could have been I was merely dreaming about visualising. Or visualising my dreams. It all gets a bit blurry.

Just returning to the visualisations in earnest today, and expecting to have slipped backwards a bit. Nothing wrong there — further integration of the practice with daily life. Next time food poisoning strikes, it’ll be the second time it’s happened since I changed my brain’s wiring. I wonder if I’ll even be visualising still, then?

Today has been a busy day, and I’ve managed to ride it out with little drama by remembering to slow down and visualise at certain times. Transitions between activities are a classic time to forget the technique and just race ahead with the next thing — but pain is functioning beautifully as a messenger to be mindful and do the practices that unwind my brain.

I’m now pretty convinced of the technique’s effectiveness. There will be future setbacks, but I’m excited.

I have another piece I’m writing about this stuff and the crossover between it and mindfulness / vipassana. But it will have to wait as there’s more research required. Watch this space.

Pain is not an enemy — it is an important messenger in our bodymind. It is a protective mechanism that saves our lives through letting us know about our environment. We’re going to need a frequent stream of those messages to keep ourselves safe. Getting rid of them is not realistic, or even desirable. It’s also not what this technique is about.

What the neuroplastic hack I’m crafting should accomplish is the ability to feel pain normally again. Without it spilling over into a large-scale take over of important brain processing regions.

The only reason that spillover is happening in the first place is because my brain has done its job. It’s not a malfunction or some kind of disorder — it’s a side effect of repeat pain signals (nociception) from the peripheral nerves. They have kept the pain centres of my brain in a state of alert. The actual biology of this is fascinating. I am not a doctor, but this is my understanding: inflammation, as it becomes chronic in the site of injury, eventually generates a flurry of rapid-fire signals that set up long-term activation in the pain regions of the brain. Once this long-term activation occurs, neurons can continue to fire off signals for days or even years, without receiving any new triggers. They become self-activated. This particular state (called Long-Term Potentiation) also triggers the release of a specific pain neurotransmitter called Substance P. Substance P then traverses the spinal cord to the periphery where it triggers the release of further inflammatory molecules from cells in the fascia called fibroblasts. An unending cycle of triggers has been established.

Enter the 1st Law of Neuroplasticity: What Gets Fired, Gets Wired. This law describes the experiential bias in our brain pathways: the more we use a given network, the more priority is given to it and the larger its physical size within our brain. The unending inflammatory cycle I outlined in the earlier, coupled with the 1st Law, leaves us primed to fall afoul of chronic pain. If we do not intervene, we will continue to add wiring to the pain pathways, until we see an increase in neuronal involvement in pain from 5% of neurons in a “normal” brain, up to 15% or even 25% in a brain with chronic pain syndrome.

That’s a lot of processing power been commandeered by the pain, when it could be being used to remember things or form sentences or make plans.

What Gets Used Gets Enthused (I just made that up). My brain has become better and better at feeling pain because that’s been a continual source of stimulation for so long. What I’m doing with the neuroplasticity hack, is to benefit from our structural understanding of the brain in the 21st century, and to apply some formidable human abilities:

to direct my focus

to sustain attention

to practise meta-cognition (thinking about what we’re thinking)

We use these capabilities we’re blessed with, to steer our mind away from pain whenever it is detected. To receive the message, but to intervene with the very neurons the pain regions need to use for their wind up, and instead give them a different job to do. What Gets Fired Gets Wired. We can use the 1st Law as a virtue and not a curse.

By cognitively altering the firing pattern in our pain networks, they will, over time, rewire themselves so that eventually we do not need to cognitively do the work. It’ll be part of the firmware — a habit, if you like, subconscious and lightning quick.
It takes a while for the cognitive effort to tip the balance though. There’s a lot of pain habit built into those networks, and the brain is weighted towards experience. It won’t just drop years of wiring in favour of a week’s stimulus — or even six weeks.

Although the improvements should be starting to take place for me in the next few weeks, it’ll take months for them to truly set themselves as the new normal. And I’ll have to stay vigilant with every pain spike for the rest of my life, to keep the pain habit from reforming, because the injury and others will continue to be a source of niggles from time to time.
So no, the goal is not to live some kind of pain-free celestial existence. This is more pragmatic than that.